ILIBRARY OF CONGRESS J 
# -. : ■# 

f [SMITHSONIAN DEPOSIT.] i 

^ ^ ■«-«-^ >^ ^ 

! UNITED STATES OF AMERICA.^ 



EXPOSITIONS 



NATIONAL MEDICIA^E 



BRIEF EXPOSITIONS 



RATIONAL MEDICINE 



TO WHICl 



JACOB BIGELOW, M. D., 



BOSTON: 



PHILLIPS, SAMPSON AND COMPANY, 

13 Winter Steeet. 

1858. 




Entered according to Act of Congress, in the year 1858, by 

PHILLIPS, SAMPSON & CO., 

In the Clerk's Office of the District Court of the District of Massachusetts 



stereotyped by 

HOBART & ROBBINS, 

New England Type and Stereotype Foundery^ 



CONTENTS. 



PAGE 

Dedication, 3 

The Paradise of Doctors ; A Fable, . . . 7 

Bribe Expositions of Rational Medicike, . . 23 

Appendix, 61 



TO Sm JOHN FORBES, M.D., F.R.S., 

FELLOW OF THE EOTAL COLLEGE OF PHYSICIANS, LONDON, 
PHTSICLiN OF THE QUEEN'S HOUSEHOLD, &C. &C. 

My dear Sir : 

The distinguished and influential position -which 
you hold in regard to principles, many of which are 
advocated in this little publication, renders it proper 
that I should present it to your notice as an humble 
auxiliary in the promotion of a just, and, I hopefully trust, 
a growing conviction in the public mind, as to the true 
mission and powers of the medical art. 

It is known to you that it was my intention to have 
published in this country an edition of your very able 
volume entitled "Nature and Art in the Cure of Disease," 
in connection with some other publications of like tendency 
which have appeared on this side of the Atlantic, and 
to have embodied the whole under the title of " Rational 
Medicine." Of this plan, as well as name, I had the 
pleasure to receive your approval and your concurrence 
in its execution. But after the whole was prepared, and 



IV DEDICATION, 

placed in the publisher's hands here, the unforeseen ap- 
pearance of a New York edition of your work rendered 
superfluous the proposed undertaking. 

The world will duly appreciate the labor and learning 
which, during half a century, you have brought to the 
aid of true medical philosophy, and, in a particular man- 
ner, the impartial investigations which you have lately 
made in regard to the part performed by nature in the 
cure of diseases. Convictions in a measure similar to 
your own have, at the same time, found their way into 
other minds, and generally in a near proportion to the 
testimony afforded by prolonged experience. Twenty- 
eight years ago I read before the Medical Society of this 
State a Discourse on Self-limited Diseases, which, I have 
reason to believe, was not without some influence at the 
time and since on the minds of the profession here. This 
discourse was afterwards incorporated, with other essays, 
in a volume entitled " Nature in Disease." I now hope 
that the crowning and convincing testimonies afforded by 
your noble work on the comparison of nature and art in 
the cure of disease wijl be instrumental in causing the 
extravagances of a so-called heroic and overactive prac- 
tice on the one hand, and of a nugatory and ignorant 
practice on the other, to be replaced by something which 
may deserve the name of Rational Medicine. 



DEDICATION. V 

If an apology is due for so far departing from the 
accustomed gravity of science as to introduce at the com- 
mencement of this little book a fable called The Paradise 
of Doctors, it must be derived from the fact that, in this 
age of overproduction in all departments of literature, 
the public ear is sometimes attracted by exaggeration to 
give its attention afterwards to more chastened expositions 
of the truth. 

I am, dear Sir, 

With much respect and regard, 
Yours, 

JACOB BIGELOW. 
1* 



THE PARADISE OF DOCTORS. 

A FABLE. 



READ AT THE ANNUAL DINNER OP THE MASSACHUSETTS MEDICAL SOCIETT, 

MAT 26, 1858. 



It happened, once, that a general awakening 
took place among the physicians, druggists and 
citizens, of the quiet old State of Massachusetts, 
during which it was discovered that a great 
and culpable neglect had long been prevalent 
throughout the community in regard to the im- 
portant duty of taking physic. A conviction 
fell upon aU that it was now imperatively neces- 
sary that every man, woman and child, should 
proceed at once and habitually, in sickness and 
in health, to take three times as much medicine 
as they had taken before. This new revela- 
tion, explained and enforced by competent 



8 THE PAEADISE OF DOCTORS. 

authorities, quickened into sudden activity every 
department of industry connected with the pre- 
paring, prescribing and dispensing, of drugs. 
The repose of cities was disturbed, in a manner 
not before known, by the rattling of doctors' car- 
riages and the braying of apothecaries' mortars. 
Messengers were seen rapidly traversing streets 
and roads in all directions, bearing prescrip- 
tions and compositions. Nurses' wages were 
doubled, and cooks were transformed into 
nurses. All things gave evidence that a great 
and portentous reform had come over the 
land. 

In all places of business and amusement, in 
the street and in the drawing-room, physic was 
the paramount subject of conversation. News- 
papers neglected to announce the arrival of 
steamers, and the brawls of Congress, that they 
might find place for the last astonishing cures, 
and the most newly-discovered specifics. Sympa- 
thetic intercommunications and experiences were 
imparted, and listened to M'ith untiring avidity. 
Many luxuries unknown before found their way 
into society, dinners were regularly medicated, 



THE PAEADISE OP DOCTOES. 9 

wines scientifically sophisticated, and desserts 
were made up of conserves, electuaries and din- 
ner-pills. The atmosphere was redolent with the 
incense of aloes and myrrh. 

Clergymen and moralists forgot that men were 
sinful ; it was quite enough that they were bil- 
ious. Bile was regarded as the innate and orig- 
inal sin, which was to be extirpate'd with fire and 
physic even from the new-born child. Nobody 
was aware that bile is necessary to life ; no two 
persons were agreed as to what the term hilious 
meant ; it was something insidious, mysterious 
and awful. Some held that it consisted in having 
too much bile ; others in having too little. Ac- 
cording to some, the bile was held back in the 
blood; according to others, it was absorbed ready 
formed into the blood. Pierce schisms and sects 
were generated on the question who, and whether 
any, were exempt from its contaminating pres- 
ence. The bon vivant, after his night's carouse, 
furnished abundant demonstrations of its exist- 
ence on the following morning. A healthy la- 
borer, who had had the temerity to boast of his 
freedom from bilious taint or suspicion, was con- 



10 THE PARADISE OF DOCTORS. 

victed and brouglit to his senses by the ordeal 
of a dozen grains of tartar-emetic. 

On the exchange, brokers postponed their 
stocks and bonds, that they might pubhsh daily 
lists of the prices of drugs. Fortunes were, 
made and lost in drug speculations. A man 
grew rich by a patent for manufacturing Peru- 
vian bark out of pine saw-dust. Gilded pills, of 
various weight and potency, passed as a circu- 
lating medium, and were freely taken at the shops 
in payment for better goods. Finally, the physi- 
cians did not attempt to eat or sleep, but barely 
found time to enter their daily professional 
charges. They were worshipped and run after, 
by both sick and well, as the legitimate vehicles 
of medicine, and were ignominiously deserted 
if in any case they ventured to pronounce med- 
icine unnecessary. 

The fame of these doings went abroad, and 
Massachusetts acquired the enviable celebrity of 
being the Paradise of medical men. The doctors 
in New Hampshire, and the druggists in New 
York, hearing of the success of their profes- 
sional brethren in this quarter, began to abandon 



THE PAEADISE OF DOCTOES. 11 

their establishments and remove into Massachu- 
setts. The example was followed in other states ; 
new recruits were drawn from the counter and 
the plough, and in a short time the country and 
city were inundated by swarms of medical prac- 
titioners of all denominations. Agreeably to the 
acknowledged law of commerce and political 
economy, that demand and supply necessarily 
regulate each other, the business of many per- 
sons, which had undergone an undue exaggera- 
tion, was at length found rapidly to decline 
under increasing competition, and the aggre- 
gate receipts of the year were found, to the 
cost of not a few disciples of Esculapius, to 
be less than they had ever been before. Med- 
icines became drugs, and the Paradise of Doctors 
became an excellent place for doctors to starve 
in. Nevertheless, although the market was as 
much glutted as the people, still a large surplus 
both of zeal and physic remained to be worked 
off in some way. 

Meanwhile, the revival went on, and its effects 
began to tell upon the faces and movements of 
the people. There was a deficiency -in the will 



# 



12 THE PAEADISE OF DOCTORS. 

to undertake, and the power to execute, even 
common enterprises. Men went languidly to 
their respective places of business, or stayed at 
home if it was their day to take a purgative or an 
emetic. Purses were found to be lightened, and 
the contour of persons grew sensibly less. In one 
thing only the economy of living was promoted : 
owing to the decline of appetite, the consump- 
tion of food was much diminished. Under this 
order of things it was noticed that labor and 
exercise were little in vogue, and people betook 
themselves in preference to the occupation of 
doing nothing. A small number, it is true, made 
a desperate effort to eifect a change by doubling 
their doses of physic ; but the result did not 
encourage a repetition of the experiment. At 
last a cholera came, and, although a forty-drug 
power was promptly brought to bear upon it, 
the mortality was greater than it had ever been 
known to be before. 

Nevertheless, weak-minded men and strong- 
minded women failed not to harangue audiences 
in the streets on the astonishing powers of med- 
icine. Spirit-rappers were summoned to evoke 



THE PAEADISE OF DOCTOES. 13 

from their rest the heroic shades of Rush and 
Bouillaud, Sangrado, Morrison and Brandreth. 
These distinguished worthies exhorted their fol- 
lowers not to shrink or falter under the trials 
to which they were subjected, but rather to. 
redouble their perseverance, until the truth of 
the faith which they held should be established 
by the testimony of their martyrdom in its- 
cause. 

At length a meeting accidentally topk place 
between two old shipmasters, one of whom had 
lost overboard his barrel of beef, and the other 
his medicine-chest, in a gale of wind at the com- 
mencement of their passage. On examination, 
and comparison of their respective crews, the 
contrast was so marked bet^veen the ruddy faces 
of the latter, and the lantern-jaws of the former,, 
that a general mutiny sprang up in both crews 
against the further tolerance of the physic-taking 
part of their duty. The contagious insurrection 
spread from Fort Hill to Copp's Hill; and on 
the following night several medicine-chests were, 
thrown overboard by men in the disguise of 
South-sea Islanders. 
2 



14 THE PAEADI3E OF DOCTOKS. 

The spark which had struck the magazine 
caused the whole po]Dulation to explode. A 
universal mass-meeting was called upon Boston 
Common, and protracted through several days 
and nights. Agitators, refdrmers and stump- 
orators, delivered their harangues, and defined 
their positions. Many speakers advocated an 
immediate application to the Legislature, calhng 
on tliem to prohibit, by an especial act, all further 
traffic in drugs. One, more violent than the rest, 
demanded that the meeting should resolve itself 
into a committee of vigilance, for the purpose of 
making a descent upon the a^^othecaries' shops, 
and emptying the contents of their bottles into 
the streets. He was wilhug to allow to offend- 
ers themselves the option to quit within twenty- 
four hours, or swallow their own medicines. A 
more moderate citizen said he rose in support of 
the general sentiment, but would offer an amend- 
ment, that,- in the contemplated destruction, an 
exception should be made in favor of Bourbon 
whiskey. A few of the advocates of the policy 
lately prevalent attempted to make themselves 
lieard ; but their voices were so attenuated, by 



THE PAEADISE OF DOCTORS. 15 

the long use of jalap and salts, that they failed to 
produce any considerable impression. 

An old lady, whose shrill voice drew immediate 
attention, protested against violent measures of 
all kinds, and moved, as a middle course, that 
resort should be had to homoeopathy. It never 
did any harm, and was very comforting, espec- 
ially when well recommended by the physician. 
It cured her child of the measles in sis weeks, 
and herself of a broken leg in six months, during 
which time she had two hundred and ninety- 
five visits, and took more than fifteen hundred 
globules. She had walked to the meeting on her 
crutches to exhibit to the assembly the astonish- 
ing powers of the Hahnemannic system. Here 
she was interrupted by a bluff marketer, who 
somewhat rudely pronounced homoeopathy to be 
a great humbug, since, but a short time before, his 
child had eaten part of a raw pumpkin, and was 
seized with convulsions ; and the physician who 
was sent for, instead of taking measures to dis- 
lodge the offending cause, took out a little book, 
and remarking to the by-standers that "like 
cures like," proceeded to prescribe the hundred 



16 THE PARADISE OF DOCTORS. . 

millionth part of another pumpkin. — The n'fext 
person who rose was a manufacturer, who had 
calculated that the homceopathic profit on the 
cost of the raw material was altogether unreason- 
able. He had himself expended seventy-five 
dollars in a quarter of a grain of belladonna, so 
divided as to keep off scarlet fever ; but found, 
after all, that he had not bought enough, for his 
children had the disease a little worse than any 
of their neighbors. 

At last an old gentleman, moderately endowed 
with common sense, got up, and inquired if 
there was no such thing in the world as rational 
medicine, and whether nothing could be made 
acceptable to the public but extremes of absurd- 
ity. He asked if it was necessary that every 
theologian should be a Calvinist or an atheist, or 
every voter at the polls an abolitionist or a fire- 
eater." He had had the good fortune to know 
several very sensible, straight-forward physicians, 
who gave medicine where it was necessary, and 
omitted to give it where it was unnecessary or 
detrimental. He deprecated the routine prac- 
tice which, without undcrstandins; the nature of 



THE PARADISE OF DOCTORS. 17 

a disease, or the necessities of the existing case, 
inflicted a daily or hourly dose of medicine, 
sometimes actual and sometimes nominal, but 
always at the cost of the patient. Medicine, in 
its place, was a good thing, but proved a bad 
thing when we got too much of it. He had 
himself had the misfortune to be several times 
sick, and, during the continuance of his disease, 
felt much more gratified on those days in which 
it was announced that he was to take no medi- 
cine, than when tartar emetic was replaced by 
calomel, and calomel by colchicum, aconite, and 
the last new remedy. If patients and their 
friends were ignorant and unreasonable, it might 
sometimes be necessary to deal with a fool ac- 
cording to his folly ; but he believed that sensible 
men and women were gratified by being regarded 
and treated as reasonable beings. It was a mis- 
take in medical, men to suppose that their influ- 
ence or social position could be improved by the 
mystery which they observed, and the activity 
with which they harassed their patients. In Great 
Britain, an island where the people subsist largely 
on blue pills and black draughts, the doctors were 



18 THE PARADISE OF DOCTORS. 

never known to attain the high aristocratic rank 
which was occasionally accorded to successful 
bankers, jurists and generals. On the contrary, 
the country was overflowed with starved apothe- 
caries and physicians advertising for situations 
as traveUing servants. He thought one of the 
greatest misapplications of human industry was 
in the production of superfluous drugs and drug- 
dispensers. He did not believe in the transmu- 
tation of metals, but was a great believer in 
their transportation. In the form of calomel, the 
city of New Orleans alone had swallowed u'p some 
hundred tons of the quicksilver of Spain and South 
America. Palaces were being built in various 
cities alike from poisonous arsenic and harmless 
sarsaparilla. . A century hence the mines of gold 
will be sought for, not in California, but in the 
cemeteries of the old cities, where it has been 
geologically deposited under the industry of 
dentists. 

He beheved that the experienced and intelli- 
gent part of the medical profession had long 
since arrived at. the conclusion that many dis- 
eases were self-limited, and that time and nature 



THE .PAEADISE OF DOCTORS. 19 

had quite as much to do as art in the process 
of their cure. Skilful physicians were always 
wanted to inform the sick of the character of 
their diseases, and of the best mode of getting 
through them ; and their skill consisted not in 
the abundance of their nominal remedies, but in 
the judgment with which a few remedies were 
administered or withheld, and in the general safe 
conduct of the patient. Some diseases are cura- 
ble by art, and others are not ; yet, in the treat- 
ment of all diseases, there is a right method and 
a ^rong, and too much activity is quite as injuri- 
ous as tao little. A good shipmaster or pilot 
could often navigate his vessel in safety, though 
he could not cure the storui by which its safety 
was endangered. He believed that medicine 
would have fulfilled its true mission when doc- 
tors should have enlightened the public on the 
important fact that there are certain things which 
medicine can do, and certain other things which 
it cannot do, instead of assuming for it the 
power to do impossibilities. Among the good 
effects which must ensue from this diffusion of 
light would be the disappearance of quackery 



20 THE PARADISE OF DOCTORS. 

from the world ; for quackery consists almost 
wholly in medication. And the more physicians 
lend themselves to formal, superfluous and mys- 
terious drugging, the more nearly do they ap- 
proach to being quacks themselves. He con- 
sidered physicians an important and necessary 
class, to whose charge the sick always had been, 
and always would be, committed. He would 
gladly cleanse the profession from the fanaticism 
of heroic doctors on the one hand, and of moon- 
struck doctors on the other, and would replace 
these forms of delusion by a discriminating, 
sincere, intelligent and rational, course of treat- 
ing diseases. 

The old gentleman sat down, and his speech 
seemed good in the eyes of his audience. Reso- 
lutions were moved and adopted to the effect 
that it was unbecoming a free and enlightened 
people to be drug-ridden or globule-ridden, and 
recommending recourse to temperance, exercise, 
regularity and rational medicine, whenever it 
happened that medical treatment was necessary. 

The meeting quietly dissolved, and its mem- 
bers returned to their respective homes, most of 



THE PARADISE OF DOCTORS. . 21 

them satisfied that the revival was past, and that 
medicine was not altogether the one thing need- 
ful. In a short time the price of drugs fell in the 
market, while that of provisions advanced. The 
New Hampshire doctors and the New York 
druggists, finding their oecupations gone, re- 
turned to the places from which thej respect- 
ively came. The surplus of indigenous medical 
men went off to California, or retired to culti- 
vate the earth in the interior counties. Faces 
assume'd a more vigorous and healthy aspect, and 
the country once more resounded with the 
music of the axe and the hammer, and the cheer- 
ful rattling of knives and forks. Steam-engines, 
which had been erected for the pulverization of 
drugs, were attached to saw-mills and spinning- 
jennies. Last of all, a noble and useful art, 
which had long been depressed under the effects 
of its own exaggeration, was enabled once more 
to raise its respeetable head, and to regain the 
confidence of society, under the name of Rational 
Medicine. 



BRIEF EXPOSITIONS 

OF 

RATIONAL MEDICINE 



The tendency to ultraism, wliicli influences 
public opinion in great social questions, par- 
ticularly of politics and theology, has been 
also prevalent in the affairs of practical medi- 
cine. No age has been exempt from diversity . 
of opinion among phj^sicians on the speculative 
subjects of their art; and the present period 
appears to be more marked than preceding ones 
by the opposite methods of treatment pursued 
by medical men in the management of disease. 
These methods consist, for the most part, in a 
vehement, officious and over-drugging system 
on the one hand, and an inert, evasive and nuga- 
tory practice on the other. Between these ex- 
tremes the intermediate truth meets with less 



24 EXPOSITIONS OF EATIONAL MEDICIXE. 

consideration than it ought to receive from un- 
biased and enlightened inquirers. 

Extreme doctrines in practical subjects often 
arise from the self-interest of those who originate 
and first promote them. But the vehemence and 
fanaticism with which they are afterwards pur- 
sued are as often owing to the creation of false 
issues, which divert public attention from the 
substance to the shadow, and mystify the general 
question with minor, partial* and frequently ir- 
relevant considerations. 

The introduction into the English language, 
for example, of the term " allopathy," and its 
adoption by some medical writers, has had the 
effect to mislead superficial readers in regard to 
the true issue of questions connected with the 
treatment of disease. This word was designed 
.by its zealous, but weak and incompetent, in- 
ventor to express the employment of remedies 
which produce phenomena different from those 
produced by the disease treated ; whereas the 
term homoeopathy indicated a mode of treating 
diseases by employing medicines which are sup- 
posed to produce effects similar to those wliich 



EXPOSITIONS OF EATIONAL MEDICINE. 25 

it is desired to remove. This theoretical and 
absurd generalization, wholly unsupported by 
general facts on either side, so far as the cure of 
diseases is concerned, has acquired currency 
among the less enlightened part of the public, so 
that, at the present day, many persons consider 
homoeopathy a sort of general law, to which al- 
lopathy is an exception. And, strange to tell, 
many otherwise sensible physicians have assumed 
the cloak thus offered to them, without perceiv- 
ing that the propriety of so doing is the same as 
if the whole protestant world were to style them- 
selves heretics, because the Church of Rome, in 
former ages, saw fit to apply to them that appel- 
lation. Allopathy is, in fact, a worthless term, 
which either means nothing real, or else em- 
bodies so many dissimilar and discordant ele- 
ments that it serves no purpose as a descriptive 
or distinctive name. The' occasion still exists 
for terms which may definitively express the 
dogmas of modern practice. 

Anatomy, physiology, and to a certain extent 
pathology, may be considered, so far as our dis- 
coveries have advanced, to be entitled to rank 
3 



26 EXPOSITIONS OF EATIONAL MEDICINE. 

with the exact sciences. But . therapeutics, or 
the art of treating diseases, hke ethics and politi- 
cal economy, is still a conjectural study, inca- 
pable of demonstration in many of its great pro- 
cesses, and subject to various and even opposite 
o]3inions in regard to the laws and means which 
govern its results. 

The methods which, at the present da}^, are 
most prevalent in civilized countries, in the treat- 
ment of disease, may be denominated the follow- 
ing : 

1. The Artificial method, which, when carried 
to excess, is commonly termed heroic, and which 
consists in reliance on artificial remedies, usually 
of an active character, in the expectation that 
they will of themselves remove diseases. 

2. The Expectant method. This consists 
simply in non-interference, leaving the chance of 
recovery to the powers of nature, uninfluenced 
by interpositions of art. 

3. The Homoiopatliic method. This is a coun- 
terfeit of the last, and consists in leaving the 
case to nature, while the patient is amused with 
nominal and nugatory remedies. 



I 



EXPOSITIONS OF EATIOJTAL MEDICINE. 27 

■ 4. The Exclusive method, which applies one 
remedy to all diseases, or to a majority of 
diseases. This head includes hydropathy, also 
the "use of various mineral waters, electrical 
establishments, etc. Drugs newly introduced, 
and especially secret medicines, frequently boast 
this universality of application. 

5. The Rational method. This recognizes 
nature as the great agent in the cure of diseases, 
and employs art as an auxiliary, to be resorted to 
when useful or necessary, and avoided when 
prejudicial. 

The foregoing methods, with the exception 
perhaps" of the last, have had their trial in various 
periods and countries, and have given rise to 

discussions and controversies which are not ter- 

» 

minated at the present day. The subject is too 
complicated to obtain from inquirers, out of the 
profession, the amount of attention requisite for 
understanding its merits ; while, among medical 
men, consistency to pledged opinions, defects 
of knowledge, and considerations of interest, not 
Tinfrequently warp the judgment of otherwise 



28 EXPOSITIONS OF EATIONAL MEDICINE. 

honest and discerning persons. It is certain, 
moreover, that medical opinion on the treatment 
of disease changes much between the time of 
one generation and another. Any person who 
will take the trouble to inspect the medical 
journals published thirty or forty years ago will 
find many things, then laid down as medical 
truths, which are now generally admitted to be 
medical errors. The length of a common profes- 
sional life is sufficient to disabuse most physi- 
cians of many convictions which they had re- 
ceived on trust, and once considered unchange- 
able. Yet, it does not always happen that error 
is replaced by truth, and it is fortunate if the 
delusions of ill-balanced minds are not succeeded 
by newer and greater delusions. 

It is, nevertheless, right that intelligent and 
reasonable physicians should receive the con- 
fidence of the community, since they are, or 
should be, more qualified than other persons to 
undertake the care and conduct of the sick. 
And even if it had happened that their power 
was limited to merely understanding the nature 
of the existing disease, and the import and prob- 



EXPOSITIONS OF EATIONAL MEDICINE. 29 

able tendency of symptoms which occur from 
day to day, without any attempt at curative in- 
terference, still their attendance would be 
solicited to throw light on the grave questions 
of pain, sickness, and recovery, and still more of 
life and death. The public, however, expect 
something more of physicians than the power of 
distinguishing diseases, and of predicting their 
issue. They look to them for the relief of their 
sufferings, and the cure or removal of their comr 
plaints. And the vulgar estimate of the powers 
of medicine' is founded on the common accepta- 
tion of the name, that medicine is the art of cur- 
ing diseases. That this is a false definition, is 
evident from the fact that many, diseases are in- 
curable, and that one such disease must at last 
happen to every living man.'^ A. far more just 
definition would be, that medicine is the art of 
understanding diseases, and of curing or reliev- 
ing them when possible. If this definition were- 
accepted, and its truth generally understood by 
the profession and the public,, a weight of super- 

* See the author's "Nature, -in. Disease," page 64.. 

3-^ 



30 EXPOSITIONS OF RATIONAL MEDICINE. 

fluous responsibility on one side, and of dissatis- 
faction on tlie other, would be lifted from the 
shoulders of both. It is because physicians 
allow themselves to profess and vaunt more 
power over disease than belongs to them, that 
their occasional short-comings are made a ground 
iof reproach with the community, and of conten- 
tion among themselves. 

It is now generally admitted by intelligent 
physicians that certain diseases, the number of 
which is not very great, are at once curable by 
medical means. Yet, there is probably no cura- 
tive agent, applied to such diseases, the efficacy 
and even safety of which has not been warmly 
contested by sectarian j)i'actitioners. It is also 
beginning to be admitted in this ■ country that 
■certain diseases are self -limited ^■^ incurable now 

* This term was first introduced by the writer in a discourse in 
1835, ali-eady alluded to, with the following definition : " A self- 
'limited disease is one which receives limits from its own nature, 
and not from foreign influences ; one which, after it has obtained 
foothold in the system, cannot, in the present state of our knowl- 
edge, be eradicated or abridged by art, but to whick there is due 
a certain succession of processes, to be completed in » je- tain timts 



I 



EXPOSITIONS OF RATIONAL MEDICINE. 31 

by artj yet susceptible of recovery under natural 
processes, both with and without the interference 
of art. To this class belong a great portion of 
the diseases usually called acute, and likewise 
some, the character of which is decidedly 
chronic. Lastly, a vast tribe of incurable dis- 
eases takes precedence in the lists of mortality, 
and holds, in some form, its final sentence over 
the heads of all mankind. Yet, so reluctant are 
physicians to acknowledge these universal truths, 
or to admit their own incompetency, that incu- 
rable and unmanageable diseases have been com- 
placently called opprohria inedicinoe, as if they 
were exceptions to a general rule. 

The great objects which medical practice pro- 
fesses to effect, and which there can be no doubt 
that it frequently does effect, are the following : 
1. The cure of certain diseases. 2. The relief or 
palliation of all diseases. 3. The safe conduct of 

■which, time and processes may vary with the constitution and 
condition of the patient, and may tend to death or to recovery, 
but are not known to be shortened, or greatly changed, by medical 
treatment." 



32 EXPOSITIONS OF RATIONAL MEDICINE. 

the sick. In all these objects it sometimes 
fails; yet, instances of its success are sufficientlj 
numerous to establish the necessity of the ex- 
istence of medicine as a profession. 

No one doubts that morbid affections, oc- 
casioned by the presence of an offending or 
irritating cause, are often spee'dily cured by the 
discharge or removal of that cause. And here 
drugs are among the principal agents which we 
employ. Again, no one doubts that many of the 
diseases of civilized life, brought on by luxury, 
intemperance, sedentary and intellectual labor, 
unhealthy residence, occupation, etc., are often 
wholly or partially cured by change of life, in- 
cluding habits, and perhaps residence. And here 
drugs are, for the most part, of little avail. So 
that it may happen that the chance of cure shall 
depend upon the judgment with which active 
drugs are administered, on the one hand, and 
avoided or superseded, on the other. 

The palliation of diseases is another great 
practical end of medical science, and really occu- 
pies a large portion of the time and efforts of 
every medical man. When it is considered that 



EXPOSITIONS OF EATIONAL MEDICINE. 33 

most diseases last for days, and some of tliem for 
years, and that a large portion of mankind event- 
ually die of some chronic or lingering disease, 
it will readily be seen that the palliation of suffer- 
ing is not only called for, but really constitutes 
one of the most important, as well as beneficent 
objects of medical practice. The use of ano- 
dynes and ansesthetics, the obviation of various 
painful and distressing symptoms, the removal 
of annoyances, the just regulation of diet, of ex- 
ertion and repose, of indulgence and restric- 
tion, the direction of moral agencies, which 
make up so large a part both of suffering and 
relief, may well afford employment to the most 
earnest and philanthropic physician, and obtain 
from the public a just ajapreciation of the value 
of his services. 

The safe conduct of the sick, as will be seen 
from the last head, consists much more in caution- 
ary guidance than in active interference. In the 
management of sickness, the rein is needed to 
direct quite as much as the spur to excite. 
People sometimes suffer from neglect, but more 
frequently from ill-judged and meddlesome atten- 



34 EXPOSITIONS OF EATIONAL MEDICINE. 

tion. One of the most cogent necessities of a 
sick man is to be saved from the excessive and 
officious good will of his friends. The kindest 
impulses and the most benevolent intentions are 
liable to show themselves in ill-timed visits, 
fatiguing conversations, and injudicious advice 
or action. Intelligent and discreet physicians are 
sometimes driven by the importunity of friends 
to the adoption of active measures, or at least the 
semblance of them, which their own judgment 
informs them would be better omitted. And the 
case is still worse when the impulsive tempera- 
ment of the physician himself, or the influence of 
his early education, or the dominant fashion of 
the place in which he resides, is so exacting in 
regard to activity of treatment as to make him 
believe that he cannot commit too many inflic- 
tions upon the sick, provided that, in the end, 
he shall be satisfied that he has omitted nothing. 

The foregoing desiderata, the cure, the relief, 
and the safe conduct of patients, involve the 
great objects for which medicine has been striv- 
ing for thousands of years. Yet, even in the 
present advanced state of science, physicians are 



EXPOSITIONS OF RATIONAL MEDICINE. 35 

not agreed as to the means by which any one of 
them is to be accomphshed or attempted ; and 
a man who fahs sick at home or abroad is hable 
to get heroic treatment or nominal treatment, 
random treatment or no treatment at all, accord- 
ing to the hands into which he may happen to 
fall. It is, therefore, desirable that physicians 
themselves, and the public also, should obtain a 
satisfactory understanding of the various diver- 
sities of practice which have been already men- 
tioned as occupying the greatest share of atten- 
tion at the present day. 

1. The Artificial Method. — This mode of 
treatment is founded on the assumption that 
disease can be removed by artificial means. 
Prom the earliest ages a belief has prevailed that 
all human maladies are amenable to control 
from some form of purely medical treatment; and 
although the precise form has not yet been found, 
so far as most diseases are concerned, yet, at this 
day, it continues to be as laboriously and hope- 
fully pursued as was the elixir vitcB in the middle 
ages. Within the present century, books of prac- 
tice gravely laid down '^ the indications of cure," 



36 EXPOSITIONS OF EATIONAL MEDICINE. 

as if they were things within the grasp of every 
practitioner. It was only necessary to subdue 
the inflammation, to expel the morbific matter, to 
regulate the secretions, to improve the nutrition,- 
and to restore the strength, and the business was 
at once accomplished. What nature refused, or 
was inadequate to do, was expected to be 
achieved by the more prompt and vigorous in- 
terposition of art. The destructive tendencies 
of disease, and the supposed proneness to dete- 
rioration of nature herself, were opposed by 
copious and exhausting depletion, followed by 
the shadowy array of alteratives, deobstruents 
and tonics. Confinement by disease, which might 
have terminated in a few days, was protracted to 
weeks and months, because the importance of 
the case, as it was thought, required that the 
patient should be artificially '' taken down," and 
then artificially " built up." 

When carried to its " heroic " extent, artificial 
medicine undermined the strength, elicited new 
morbid manifestations, and left more disease than 
it took away. The question raised was not how 
much the patient had profited under his active 



EXPOSITIONS OF RATIONAL MEDICINE. 37 

treatment, but how much more of the same he 
could bear. Large doses of violent and deleteri- 
ous drugs were given as long as the patient 
evinced a " tolerance " of them, that is, did not 
sink under them. The results of such cases, if 
favorable, like the escapes of desperate surgery, 
were chronicled as professional triumphs, while 
the press was silent on the disastrous results 
subsequently incurred in like cases by deluded 
imitators. If diseases proved fatal, or even if 
they were not jugulated or cut short at the 
outset, the misfortune was attributed to the cir- 
cumstance of the remedies not being sufficiently 
active, or of the physician not being called in 
season. So great at one time, and that not long 
ago, was the ascendency of heroic teachers and 
writers, that few medical men had the courage to 
incur the responsibility of omitting the active 
modes of treatment which were deemed indis- 
pensable to the safety of the patient. This tim- 
idity on the score of omission has now, in a 
great measure, passed away, yet is still promoted 
in most cities by some heroic doctors, and still 
more by interested specialists, who inflict severe 
4 



38 EXPOSITIONS OF RATIONAL MEDICINE. 

discipline, and levy immense contributions, on 
credulous persons, who are suitably alarmed at 
denunciations which involve the loss of sight, of 
hearing, or even of beauty. 

A considerable amount of violent practice is 
still maintained by routine physicians, who, with- 
out going deeply into the true nature or exigen- 
cies of the case before them, assume the general 
ground that nothing is dangerous but neglect. 
Edge-tools are brought into use as if they could 
never be anything more than harmless playthings. 
It is thought allowable to harass the patient with 
daily and opposite prescriptions ; to try, to aban- 
don, to reenforce, or to reverse ; to blovv^ hot and 
cold on successive days ; but never to let the 
patient alone, nor to intrust his case to the quiet 
guidance of nature. Consulting physicians fre- 
quently and painfully witness the gratuitous suf- 
fering, the continued nausea, the prostration of 
strength, the prevention of appetite, the stupefac- 
tion of the senses, and the wearisome days and 
nights, which would never have occurred had 
there been no such thing as officious medication. 
What practitioner has not seen infants screaming 



EXPOSITIONS OF EATIONAL MEDICINE. 39 

under the pangs of hunger, or of stimulants re- 
morselessly applied to their tender skins, and 
whose only permitted chance of relief was in the 
continued routine of unnecessary calomel and 
ipecacuanha ? 

There is one great exception in favor of arti- 
ficial and even heroic practice, well known and 
fully demonstrable in the art of surgery. Many 
defects, injuries, and diseases of the body, are, 
unquestionably, cured by surgical processes, 
which never could have got well without them. 
And the skilful and humane surgeon has more 
frequent opportunities to reflect with satisfaction 
on the immediate and positive results of his art 
than the most able physician. Yet even this sat- 
isfaction can only be measured by the fidelity 
with which he has performed his duty, and the 
conscientiousness with which he has avoided 
useless and hopeless operations. Happily the 
experience and statistical results of the best 
modern surgeons have had the effect to dimin- 
ish greatly the amount of gratuitous suffering 
which was imposed by their predecessors on the 
unhappy subjects of their art. We see much less 



40 EXPOSITIONS OF RATIONAL MEDICINE. 

than was formerly seen of the cruel but unavail- 
ing operations of fanciful and interested surgery; 
the infliction of pain without corresponding good, 
the useless extirpation of malignant growths, the 
mutilation of miserable bodies already doomed 
by tuberculous and other irrecoverable condi- 
tions ; deeds which have converted hospitals into 
inquisitions, and left the Bastile and the Hotel 
Dieu to contend for the palm of supremacy in 
the production of human suffering. 

2. The Expectant Method. — This method, 
when fully carried out, admits no medication nor 
interference of art, but waits on time, and com- 
mits the chance of recovery to the restorative 
power of nature alone. The expectant practice 
has not been without its advocates, and volumes 
have been published in its favor, at different 
times, chiefly on the continent of Europe. That 
there is some basis for the doctrine of expecta- 
tion is made apparent by the spontaneous 
recovery of animals and savages, of careless, 
obstinate and incredulous persons in civilized 
life, and of those who, in consequence of their 
isolated or otherwise unfavorable position, are 



EXPOSITIONS OP EATIONAL MEDICINE. 41 

unable to procure " medical aid/' or who, if they 
do procure it, obtain only that which is inopera- 
tive or absolutely detrimental. I sincerely be- 
lieve that the unbiased opinion of most medical 
men of sound judgment and long experience is 
made up, that the amount of death and disaster 
in the world would be less, if all disease were left 
to itself, than it now is under the multiform, reck- 
less and contradictory modes of practice, good 
and bad, with which practitioners of adverse 
denominations carry on their differences at the 
expense of their patients. But there is no 
probability that expectant medicine will ever 
prevail in its character as such. The amount of 
positive good which, in fifty centuries, art has 
brought to the assistance of medicine, although 
far more limited than we could desire, is, never- 
theless, both sufficient and worthy to employ 
the talents of the best and most enlightened 
physicians. 

3. The Homceopathic Method. — Homoeopathy 
may be defined as a specious mode of doing noth- 
ing. While it waits on the natural progress of 
disease and the restorative tendency of nature 
4* 



42 EXPOSITIONS OF EATIONAL MEDICINE. 

on the one hand, or the injurious advance of dis- 
ease on the other, it supphes the craving for 
activity, on the part of the patient and his 
friends, by the formal and regular administration 
of nominal medicine. Although homosopathy 
will, at some future time, be classed with histor- 
ical delusions, yet its tendency has undoubtedly 
been to undermine the reliance on heroic prac- 
tice which prevailed in former times both in this 
country and in Europe. There was, perhaps, 
needed a popular delusion to institute the exper- 
iment on a sufficiently large scale to show that 
the sick may recover without the use of trouble- 
some and' severe medication. There are not 
wanting in history similar instances of good re- 
sults flowing from questionable sources. The 
French Revolution has eventually bettered the 
social condition of the French people ; and the 
Mormons have brought the wilderness of the 
Salt Lake to a state of productive cultivation. 
Yet no judicious person vindicates the doctrines 
of those who were prime movers in these inno- 
vations, or holds them up as worthy examples for 
imitation. Sir Kenelm Digby produced a bene- 



EXPOSITIONS OF EATIONAL MEDICINE. 43 

ficial reform in English surger}'', and was able to 
banish the prevalent mode of dressing incised 
wounds with painful applications, by speciously 
going from the effect to the cause, and applying 
the active medicament, not to the wound, but to 
the weapon that did the mischief; thus giving to 
the former a chance to heal by the first intention. 

There is great reason to believe that, at the 
present day, homoeopathic faith is not always 
kept up in its original purity by its professors. 
Traces of the occasional use of very heroic rem- 
edies are often detected among the most unsus- 
pected of its practitioners. And it must not be 
concealed that there are instances in which the 
temptation is very great, even for the most reso- 
lute convert, to come to the aid of the sick with 
reasonable and efficient doses of real medicine. 
The man must be somewhat of a stoic who 
can look upon a case of severe colic, or of the 
multiform distresses which result from overtasked 
organs of digestion, and quiet his conscience with 
administering inappreciable globules, instead of 
remedies. 

4. The Exclusive Method. — This, hke the 



44 EXPOSITIONS OF RATIONAL MEDICINE. 

heroic system, is various in its means of treat- 
ment, but differs from it in the professed univer- 
sality of its peculiar applications. ' Hydropathy 
applies one remedy, cold water, to all cases. 
Yet, like homoeopathy, it combines with its 
special agent a strict course of life, including 
exercise, temperance, regular hours, and a diet 
in the main simple and wholesome, though some- 
Avhat fanciful in its exclusions. The same was 
done so far as was proper in the previous prac- 
tice of all judicious physicians. The use of cold 
bathing is not new, having been employed as a 
hygienic process from time immemorial by the 
civilized world. As a therapeutic agent, cold 
affusion was resorted to more than half a cen- 
tury ago, and has been practiced ever since in a 
greater or less degree. But the peculiar mode 
of applying water by packing appears to be 
original with Priessnitz, an ignorant German, to 
whom it owes its popularity. Like the Russian 
bath, in Avhich alternate approaches to scalding 
and freezing are said to be followed at last by 
very delightful sensations, the hydropathic dis- 
cipline, in those who have soundness of constitu- 



EXPOSITIONS OF RATIONAL MEDICINE. 45 

tion sufficient to insure a healthy reaction, is 
followed by agreeable and often salubrious re- 
sults. Yet the ineffective character of hydrop- 
athy is seen in the multitude of disappointed 
invalids who return unrelieved from its estab- 
lishments. I have been told, by persons who 
have resided at Graefenberg, that funerals at 
that place were of constant occurrence ; and it 
is well known that Priessnitz, himself a robust 
peasant, died in the prime of life, in the midst of 
his own water-cure. 

The greatest benefit at hydropathic establish- 
ments is obtained by those who reform their 
mode of life by submitting to the restraints of 
the place. The luxurious, the indolent, the sed- 
entary, and the erratic, improve most under a 
return to regular, natural, active and temperate^ 
habits. Accordingly it is found that gout, dys- 
pepsia, lost appetite, hysteria, and the various 
forms of nervous irritability, furnish the most 
hopeful subjects for such institutions. The same- 
patients might, in many cases, obtain the ' same 
relief in another place, by pursuing the water- 
cure without the water. 



46 EXPOSITIONS OF RATIONAL MEDICINE. 

The universality of hydropathic application 
lias been somewhat diminished by prolonged 
experience. Priessnitz himself, although igno- 
rant of science, and incapable of distinguishing 
one disease -from another, at last became cau- 
tious in his selections, and nominally excluded 
diseases of the lungs from his institution. 

It is not necessary to dwell upon the various 
exclusive modes of practice, more or less univer- 
sal in their ajDplication, with which the columns 
of ne-vvspapers are daily filled. Mineral waters, 
taken at the fountain, are often of great use to 
those who require a journey or a change of 
scene. Particular springs also appear to exert a 
beneficial effect on particular maladies, though 
not panaceas, for all ills. Watering-places, which 
combine amusement with exercise, are the tem- 
porary safety-valves of over-taxed physicians, 
and happily afford arks of refuge to multitudes 
of chronic valetudinarians. Electricity supports 
one or more establishments in all large cities, 
both in its simple form, and combined with all 
other imponderable agencies of mind and matter. 



EXPOSITIONS OF EATIONAL MEDICINE. 47 

Few persons go uncured of clironic maladies 
without having given it a sufficient and satisfac- 
tory trial. Finally, the host of empirical reme- 
dies, which fill the attention of a very consider- 
able portion of this quack-ridden world, leave no . 
human maladies out of the catalogue of subjects 
to their mysterious power. The drug aloes, in 
its hundred pill combinations, levies incessant 
contributions on those who purchase the privi- 
lege of being slaves to its use. Opium, variously 
disguised with aromatics to conceal its presence, 
gives temporary but fallacious respite to fatal 
diseases, under the deceptive names of pectorals 
and pulmonics. 

It is superfluous to prolong the consideration 
of general and exclusive remedies. No person 
accustomed to witness the various morbid con- 
ditions which invade and occupy the human 
frame, active and passive, partial and general, 
trivial and dangerous, can ever consider them 
proper subjects for the same kind of treatment, 
unless, with Dr. Rush and Dr. Brandreth, he 
happens to be a believer in the unity of dis- 
ease. 



48 EXPOSITIONS OF RATIONAL MEDICINE. 

5. The Rational Method. — If no alternative 
were left to the physician and patient but the 
extreme and frequently irrational methods which 
have now been briefly described, practical medi- 
cine might well take its rank as a pseudo-science 
by the side of astrology and spiritualism. But 
the labors of earnest and philanthropic men, dur- 
ing many centuries, though often speculative, 
misguided, and terminating in error, have never- 
theless elicited enough of general truth to serve 
as the foundation for a stable superstructure. 
And, that such truth may hereafter go on to 
accumulate, it must be simply and honestly 
sought, even when its developments do not at 
once promote the apparent interest of physicians, 
nor flatter their professional pride of opinion. 

It is to sincere and intelligent observers, and 
not to audacious charlatans, that we are to look 
as the ultimate lawgivers of medical science. 
Our present defect is not that we know too little, 
but that we profess too much. We regard it as 
a sort of humiliation to acknowledge that we 
cannot always cure diseases, forgetting that in 
many other sciences mankind have made no 



EXPOSITIONS OF RATIONAL MEDICINE. 49 

greater advances than ourselves, and are still 
•upon the threshold of their respective structures. 
Medical assumption may well feel humbled by 
the most insignificant diseases of the human 
body. Take, for example, a common furunculus 
or boil. No physician can, by any internal treat- 
ment, produce it where it does not exist. No 
physician can, by any science, explain it, and 
say why it came . on one' limb and not upon 
another. No physician can, by any art, cure it 
after it has arrived at a certain height. No 
physician can, by any art, delay or retain it after 
it has passed the climax assigned to it by nature. 
And what is true in regard to a boil is equally 
true of common pneumonia, of typhoid fever, of 
acute rheumatism, of cholera, and many other 
diseases. 

In the present state of our knowledge the 
truth appears to be simply this : Certain diseases, 
of which the number is not very great, are cura- 
ble, or have their cure promoted, by drugs, and 
by appliances which are strictly medicinal. Cer- 
tain other diseases, perhaps more numerous, are 
curable in like manner by means which are 
5 



50 EXPOSITIONS OF EATIONAL MEDICINE. 

strictly regiminal, and consist in changes of 
place, occupation, diet, and habits of life. 
Another class of diseases are self-limited, and can 
neither be expelled from the body by artificial 
means, nor retained in the body after their 
natural period of duration has expired. Finally, 
a large class of diseases have proved incurable 
from the beginning of history to the present 
time, and under some one of these the most 
favored members of the human race must finally 
succumb ; for even curable diseases become in- 
curable when they have reached a certain stage, 
extent, or complication. 

It will be seen that the divisions last mentioned 
cannot be strictly reduced under the nomencla- 
ture of nosologies ; for cases, and groups of 
cases, may begin in one category and end in 
another. 

It is the part of rational medicine to study in- 
telligently the nature, degree and tendenc}^, of 
each existing case, and afterwards to act, or to 
forbear acting, as the exigencies of such case may 
require. To do all this wisely and efficiently, the 
practitioner must possess, first, sufficient know- 



EXPOSITIONS OP EATIONAL MEDICINE. 51 

ledge to diagnosticate the disease ; ^and, secondly, 
sufl&cient sense as well as knowledge to make 
up a correct judgment on the course to be pur- 
sued. In the first of these, if properly educated 
and experienced, he will be able to make an 
approximation to the truth sufficient for practical 
purposes. In the second he will have to depend 
mainly on his well-ordered and logical powers of 
self-direction ; for he will find in the recorded 
evidence of his predecessors quite as much to 
mislead as to guide him rightly. He will find 
many existing cases, in which for a time he will 
know not what to do, and in which his safest 
course will be not to do he knows not what. It 
is better to resort to a little expectancy than to 
rush into blind and reckless action. Nature, 
when not encumbered with overwhelming bur- 
dens, and when not abused by unnatural and 
pernicious excesses, is, after all, " the kindest 
mother still." Art may sometimes remove those 
burdens, and regulate those excesses ; but it is 
not by imposing new burdens and instituting new 
excesses that an end so desirable is to be at- 
tained. Before commencing any contemplated 



52 EXPOSITIONS OF RATIONAL MEDICINE. 

course of treatment, in a given case, two ques- 
tions should always be asked : 1. Will it do 
good? 2. Will it do harm? A right answer to 
these questions will not fail to produce a right 
practice. 

It is the part of rational medicine to alleviate 
the sufferings of the sick. And for this end 
alone, were there no other, physicians- would 
be necessary as a profession. For this end 
alone, any person knowingly about to encounter 
the confinement of a self-limited fever, or the 
lingering decay of a cancer or consumption, 
would invoke the guidance of a medical man 
whose judgment and skill were better than his 
own. The power of the medical art to palliate 
diseases is shown in a multitude of ways, active, 
cautious and expectant. The pain of acute 
pleurisy is relieved by venesection; that of 
pleurodynia, by anodynes and external applica- 
tions. The pain of acute rheumatism is post- 
poned by opium; that of gout, by colchicum. 
Synovitis is favorably affected by rest ; chronic 
rheumatism more frequently by exercise. De- 
mulcents, opiates, and even astringents, have 



EXPOSITIONS OP EATIONAL MEDICINE. 53 

their use in various irritations of the mucous mem- 
branes. Cathartics, laxatives, emetics, leeches, 
counter-irritants, cupping, hot and cold applica- 
tions, etc., are of benefit in various local and gen- 
eral maladies. Yet these remedies, especially 
the more energetic of them, are often employed 
when not necessary, and become, by their degree 
and frequency, rather sources of annoyance than 
of relief. Violent cathartics are followed by 
increased constipation, when milder laxatives or 
enemata would not have induced that evil. Blis- 
ters, antimonial ointments, salivation, etc., may 
continue to afflict the patient long after the dis- 
ease is gone. The effects of powerful depletion 
are felt for months, and sometimes for years. 
Excessive stimulation by vinous liquids may cre- 
ate or renew disease, or give rise to pernicious 
artificial wants. To prescribe blindly for symp- 
toms, irrespectively of their cause, is often in the 
highest degree injudicious. The alvine dis- 
charges of dysentery and typhoid fever are the 
natural ventings of an inflamed, perhaps ulcer- 
ated, membrane ; the pain and the excess may 
be abated by the gentlest anodynes, hut the 
5^ 



54 EXPOSITIONS OF EATIONAL MEDICINE. 

attempt to check them altogether would be like 
the drying up of an external ulcer, of equal 
dimensions, by the sudden application of astrin- 
gents. The object might be attained for a day, 
but the result would be pernicious. Having 
already touched upon this subject, I have only to 
add, that if many of the troublesome appliances 
and severe exactions of modern practice were 
superseded by gentler, more soothing, and more 
natural means, a good would be done to the 
human race comparable to the conversion of 
swords into ploughshares. 

.It is the part of rational medicine still to 
strive and study for the cure of diseases ; not to 
assume fallacioush^ as practical truth what has 
never been shown to be true, but rather to 
search and labor for new truth, for which it is 
never too late to hope. The rational physician 
will ever be ready to weigh and examine, can- 
didly and carefully, new practical questions and 
proposed modes of treatment, whether introduced 
for the alleviation or the removal of diseases; 
and he will recollect that although nineteen out 
of every twenty of the new methods proposed 



EXPOSITIONS OF EATIONAL MEDICINE. 55 

may be worthless, yet the twentieth may perhaps 
possess some valuable quality. It is known that 
the most established laws of science cease to be 
such when their exceptions have been detected 
and made out. Some of the most important 
advances in human knowledge have been among 
the latest in date. The great American discov- 
ery of artificial ana3sthesia has been wished and 
waited for by mankind ever since the flood ; yet 
the effectual conquest of pain is as it were a 
thing of yesterday. 

It is the part of rational medicine to re- 
quire evidence for what it admits and believes. 
The cumbrous fabric now called therapeutic 
science is, in a great measure, built up on the 
imperfect testimony of credulous, hasty, prej- 
udiced', or incompetent witnesses, such as have 
afforded authorities -for books like Murray's Ap- 
paratus Medicaminum, and Hahnemann's Orga- 
non. The enormous polypharmacy of modern 
times is an excrescence on science, unsupported 
by any evidence of necessity or fitness, and of 
which the more complicated formulas are so 
arbitrary and useless, that, if by any chance they 



56 EXPOSITIONS OF RATIONAL MEDICINE. 

should be forgotten, npt one in a hundred of 
them would ever be reinvented. And as to the 
chronicles of cure of diseases that are not yet 
known to be curable, they are written, not in the 
pages of philosophic observers, but in the tomes 
of compilers, the aspirations of journalists, and 
the columns of advertisers. 

It is the part of rational medicine to enlighten 
the public and the profession in regard to the 
true powers of the healing art. The community 
require to be undeceived and reeducated, so far 
as to know what is true and trustworthy from 
what is gratuitous, unfounded and fallacious. 
And the profession themselves will proceed with 
confidence, self-approval and success, in propor- 
tion as they shall have informed mankind on 
these important subjects. The exaggerated im- 
pressions now prevalent in' the world, in regard 
to the powers of medicine, serve only to keep 
the profession and the public in a false position, 
to encourage imposture, to augment the number 
of candidates struggling for employment, to 
burden and disappoint the community already 
overtaxed, to lower the standard of professional 



EXPOSITIONS OF EATIONAL MEDICINE. 57 

cliaracter, and raise empirics to the level of hon- 
est and enlightened physicians. 



I AM not willing to leave the subject of Ra- 
tional Medicine without more earnestly calling 
the attention of the profession in the United 
States to the admirable work of Sir John Forbes, 
already alluded to, on Nature and Art in the 
Cure of Disease, of which an American edition 
has recently appeared. No testimony of mine 
can be needed to make known the claims of one 
of the most accomplished medical scholars of 
Europe, of whose philosophic mind, vigorous 
perceptions, and clear, discriminating and impar- 
•tial judgment, this volume is a legitimate product 
and a convincing evidence. 

Neither is it necessary to inform the public 
that, as one of the pioneers in the reform now in 
progress, the same author published, in 1846, in 
the British and Foreign Medical Review, an 
elaborate article, bearing the title of " Young 
Physic," which, though somewhat startling in 



58 EXPOSITIONS OF EATIONAL MEDICINE. 

the novelty of its positions, and by many disap- 
proved for the credit given to statements of 
questionable parties, had, nevertheless, the effect, 
both in England and this country, to increase 
public attention to inquiries Avhich the present 
volume is so well adapted to satisfy. Some of 
the concluding propositions of this able article, 
not everywhere accessible to American readers, 
are reprinted as an Appendix to the present little 
volume. 

In France, perhaps more than any other coun- 
try, the natural history of disease has been 
studied irrespectively of artificial influences. 
When the modes of rigorous investigation, to 
which, in that country, the laws of morbid affec- 
tions have been submitted, shall have been car- 
ried as far as possible into the more complex and 
difficult subject of therapeutics, they will at least 
help to guard it from the errors of premature 
and speculative generalization to which the medi- 
cal world has in all ages been prone.* 

* The numerical method, so advantageously applied by Louis 
and his successors to determine approximately the pathological 
character of diseases, cannot be well applied to the more complex 



EXPOSITIONS OF EATIONAL MEDICIXE. 59 

Of the contributions to rational medicine which 
have been made in this country, it gives me 
gratification to refer to various able, just and 
eloquent discourses and essays, by my friends 
and others, which have appeared at different 

subject of medical treatment, without great caution and reserve 
on the score of inference. Things submitted to this ordeal must 
be such as have some obvious connection with each otlier ; other- 
wise we are liable to be led into error by the most careful observa- 
tion and analysis. Such would be the case if we were to attem^ 
to settle numerically the questions, whether medicine applied to a 
weapon promoted the cure of a wound, — whether the hanging of 
witches had favorably affected the duration of epidemics, — 
whether it is safe for sailors to go to sea on Friday, etc. These 
are questions which are settled by the common sense of an enlight- 
ened age, and not by numerical analysis. The extensive numeri- 
cal trials, made in diflFerent countries, on the effect of bleeding 
in pneumonia, have not yet afforded results fully satisfactory to 
inquirers. It is worthy of notice that questions of relief are more 
promptly settled than questions of duration and of safety. A man 
suffering the orthopnoea of pleurisy will lie down and breathe 
with comparative ease after venesection ; and this is sufficient 
motive for the reasonable use of that remedy. But the length 
and safety of the disease, under different modes of treatment, 
afford questions yet to be settled, if at all, by a vast amount of 
observation, by competent persons, under the various differences 
of constitution, degree, complication, season, age, etc. 



60 EXPOSITIONS OP EATIONAL MEDICINE. 

times. Among these should be distinguished a 
Discourse " On the Condition, Prospects and 
Duties, of the Medical Profession," by Edward 
Reynolds, M. D., published in 1841 ; a Discourse 
entitled " Search Nature and Know her Secrets," 
by Augustus -A. Gould, M. D., 1855 ; a Discourse 
on " Nature in Disease," by Benjamin E. Cotting, 
M. D., 1852 ; a Prize Essay* on " Rational Thera- 
peutics," by Professor Worthington Hooker, of 
]^w Haven, 1857; also a previous volume, by 
the same able and intelligent writer, entitled 
"Physician and Patient," 1849. 

If it be permitted to refer to an extra-profes- 
sional authority, bearing, nevertheless, the marks 
of much intelligent observation, I would cite, in 
behalf of the same cause, " The Rational Doctor," 
in the Household Words of Charles Dickens. 

* The prize thus awarded was liberally instituted by Dr. B. E. 
Cotting, one of the writers above 



APPENDIX. 



The following are the principal remarks of Sir 
J. Forbe^, appended as a sort of recapitulation to his 
article already referred to in the British and Foreign 
Medical Review, vol. xxi., p. 262. They are there 
submitted by him as things to be reflected and acted 
on by the medical profession. A great portion of 
them, though perhaps not all, are applicable in this 
country as well as in England. 

"1. To endeavor to ascertain, much more 'pre- 
cisely than has been done hitherto, the natural 
course and event of diseas.es, when uninterrupted by 
artificial interference ; in other words, to attempt to 
establish a true natural history of human diseases. 

" 2. To reconsider and study afresh the phj'^siolog- 
ical and curative effects of all our therapeutic 
6 



62 APPENDIX. 

agents, with a view to obtain more positive results 
than Tve now possess. 

" 3. To endeavor to establish, as far as is practi- 
cable, what diseases are curable, and what are not ; 
what are capable of receiving benefit from medical 
treatment, and what are not ; what treatment is the 
best, the safest, the most agreeable ; when it is 
proper to administer medicine, and when to refrain 
from administering it, etc., etc. 

"4. To endeavor to introduce a more philosoph' 
ical and accurate view of the relations of remedies 
to the animal economy and to diseases, so as- to dis- 
sociate in the minds of practitioners the notions of 
post hoc and proptei^ /loc* 

" The general adoption by practitioners, in record- 
ing their experience, of the system known by the 
name of the Numerical Method, is essential to the 
attainment of the ends proposed in the preceding 
paragraphs, as well as in many that are to follow. 

"5. To endeavor to banish from the treatment of 
acute and dangerous diseases, at least, the ancient 
axiom, melius anceps remedium quam nuUu7n,'\' and 
to substitute in its place the safer and wiser dogma, 

* Subsequent and consequent. 

t A doubtful remedy is better than none. 



APPENDIX. 63 

that, where we are not certain of an indication, 
we should give nature the best chance of doing the 
work herself, by leaving her operations undisturbed 
by those of art. 

"6. To endeavor to substitute, for the monstrous 
system of Polypharmacy now universally prevalent, 
one that is, at least, vastly more simple, more intel- 
ligible, more agreeable, and, it may be hoped, one 
more rational, more scientific, more certain, and 
more beneficial. 

" T. To direct redoubled attention to hygiene, 
public and private, with the view of preventing dis- 
eases on the large scale, and, individually, in our 
sphere of practice. Here the surest and most 
glorious triumphs of medical science are achieving 
and to be achieved. 

" 8. To inciilcate generally a milder and less ener- 
getic mode of practice, both in acute and chronic 
diseases ; to encourage the Expectant preferably to 
the Heroic system, — at least where the indications 
of treatment are not manifest, 

" 9. To discountenance all active and powerful 
medication in the acute exanthemata and fevers of 
specific type, as small-pox, measles, scarlatina, 
typhus, etc., until we obtain some evidence that the 



64 APPENDIX. 

course of these diseases can be beneficially modified 
by remedies. 

" 10. To discountenance, as much as possible, 
and eschew the habitual use — without any suffi- 
cient reason — of certain powerful medicines, in large 
doses, in a multitude of different diseases ; a prac- 
tice now generally prevalent and fraught with the 
most baneful consequences. 

" This is one of the besetting sins of EnglisL 
practice, and originates partly in false theory, and 
partly in the desire to see manifest and -strong effects 
resulting from the action of medicines. Mercury, 
iodine, colchicum, antimony, also purgatives in 
general, and blood-letting, are frightfully misused in 
this manner. 

"11. To encourage the administration of simple, 
feeble, or altogether powerless, non-perturbing med- 
icines, in all cases in which drugs are prescribed 
pro forma, for the satisfaction of the patient's mind, 
and not with the view of producing any direct 
remedial effect. 

" One would hardly think such a caution necessary, 
were it not that every-day observation proves it to 
be so. The system of giving and also of taking 
drugs capable of producing some obvious, effect — 



APPENDIX. 65 

on the sensations, at least, if not on the functions — 
has become so inveterate in this country, that even 
our placebos have, in the hands of our modern 
doctors, lost their original quality of harmlessness, 
and often please their very patients more by being 
made unpleasant ! 

" 12. To make every effort, not merely to destroy 
t"he prevalent system of giving a vast quantity and 
variety of unnecessary and useless di'ugs, — to say 
the least of them, — but to encourage extreme sim- 
plicity in the prescription of medicines that seem to 
be requisite. 

" Our system is here greatly and radically w^rong. 
Our officinal formulas are already most absurdly and 
mischievously complex, and our fashion is to double 
and redouble the existing complexities. This sys- 
tem is a most serious impediment in the way of 
ascertaining the precise and peculiar powers (if 
any) of the ijidividual drugs, and thus interferes, 
in the most important manner, with the progress of 
therapeutics. 

" We are aware of the arguments that are adduced 

in defence of medicinal combinations. We do not 

deny that some of these combinations are beneficial, 

and, therefore, proper ; but there cannot be a ques- 

6* 



66 



tion as to the enormous evils, speaking generally, 
resulting from them. Nothing has a greater ten- 
dency to dissociate practical medicine from science, 
and to stamp it as a trade, than this system of phar- 
maceutical artifice. It takes some, years of the 
student's life to learn the very things which are to 
block up his path to future knowledge. A very 
elegant prescriber is seldom a good physician. 

"13. To endeavor to break through the routine 
habit, universally prevalent, of prescribing certain 
determinate remedies for certain determinate dis- 
eases, or symptoms of diseases, merely because the 
prescriber has been taught to do so, and on no better 
grounds than conventional tradition. 

" Even when the medicines so prescribed are 
innocuous, the routine proceeding impedes real 
knowledge by satisfying the mind, and thus pro- 
ducing inaction. When the drugs are potent, 
the crime of mischief is superadded to the folly 
of empiricism. In illustration, we need merely 
notice the usual reference, in this country, of almost 
all chronic diseases accompanied with derangement 
of the intestinal functions, to ' affection of the 
liver,' and the consequent prescription of mercury ^ 
in some of its forms. We do not hesitate to say 



APPENDIX. 67 

that this theory is as far wrong as the practice 
founded on it is injurious ; we can hardly further 
enhance the amount of its divarication from the truth. 

" 14. To place in a more prominent point of view 
the great value and importance of what may be 
termed the physiological, hygienic, or natural sys- 
tem of curing diseases, especially chronic diseases, 
in contradistinction to the pharmaceutical or empir- 
ical drug-plan generally prevalent. This system, 
founded as it is on a more comprehensive inquiry 
into all the remote and exciting causes of disease, 
and on a more thorough appreciation of all the dis- 
coverable disorders existing in all the organs and 
functions of the body, does not, of course, exclude 
the use of drugs, but regards them (generally 
speaking) as subservient to hygienic, regimenal, 
and external means, such as the rigid regulation of 
the diet, the temperature and purity of the air, 
clothing, the mental and bodily exercise, etc., baths, 
friction, change of air, travelling, change of occu- 
pation, etc., etc. 

" 15. To endeavor to introduce a more comprehen- 
sive and philosophical system of Nosology, at least 
in chronic diseases, whereby the practitioner may 
be led less to consider the name of a disease, or 



b8 



some one symptom, or some one local affection in 
a disease, than the disease itself; that is, the whole 
of the derangements existing in the body, and which 
it is his object to remove, if possible. 

"16. To teach teachers to teach the. rising gen- 
eration of medical men that it is infinitely more 
practical to be master of the elements of medical 
science, and to know diseases thoroughly, than to 
know by rote a farrago of receipts, or to be aware 
that certain doctors, of old or of recent times, have 
said that certain medicines are good for certain 
diseases. 

" 17. Also to teach students that no systematic or 
theoretical classification of diseases, or of therapeu- 
tic agents, ever yet promulgated, is true, or anything 
like the truth, and that none can be adopted as a 
safe guide in practice. It is, however, well that 
these systems should be known, as most of them 
involve some pathological truths, and have left some 
practical good behind them. 

" 18. To endeavor to enlighten the public as to 
the actual powers of medicines, with a view to recon- 
ciling them to simpler and milder plans of treatment. 
To teach them the great importance of having their 
.diseases treated in their earliest stages, in order to 



69 



obtain a speedy and efficient cure ; and, by some 
modification in the relations between the patient and 
practitioner, to encourage and facilitate this early 
application for relief 

" 19. To endeavor to abolish the system of med- 
ical practitioners being paid by the amount of 
medicine sent in to their patients ; and even the 
practice of keeping and preparing medicines in their 
own houses. 

" Were a proper system introduced for s.ecuring 
a good education to phemists and druggists, and for 
examining and licensing them, — all of easy adop- 
tion, — there could be no necessity for continuing 
even the latter practice ; while the former is one so 
degrading to the medical character, and so fright- 
fully injurious to medicine in a thousand ways, that it 
ought to.be abolished forthwith, utterly, and forever. 

" 20. Lastly, and above all, to bring up the med- 
ical mind to the standard necessary for studying, 
comprehending, appreciating, and exercising, the 
most complex and difficult of the arts that are based 
on a scientific foundation — the art of Practical 
Medicine. And this can only be done by elevating 
the preliminary and fundamental education of the 
Medical Practitioner." 



PHILLIPS, SAMPSON & CO. 

HAVE IN PRESS, AND WILL SHORTLY PUBLISH, 

NATURE IN DISEASE, 

Illustrated in Various Discourses and Essays. To which are 

added Miscellaneous "Writings, chiefly on 

Medical subjects. 

By JACOB BIGELOW, M.D., 

PHYSICIAN AND LECT0KER ON CLINICAL MEDICINE IN THE MASSACHUSEIIS 

GENERAL HOSPITAL; PROFESSOR OF MATERIA MEDICA IN HARVARD 

university; president of THE AMERICAN ACADEMY OP 

ARTS AND SCIENCES; AND LATE PRESIDENT Or 

THE MASSACHUSETTS MEDICAL SOCIETY. 

Naturam expellas furca, tamen usque recurret. 

HOR. 

SECOND EDITION, ENLABGED. 

C O NTENTS. 
I. 

On Self-limited Diseases.. 

II. 

On the Treatment of Disease. 

HI. 

Practical Views of Medical Education. 

IV. 

Eeport on Homoeopathy. 



72 

V. 

On the Medical Profession, and Quackery. 

VI. 

On Gout and its Treatment. 

vn. 

Aphorisms on Cholera. 

VIII. 

On the Treatment of Injuries occasioned by Fire and Heated 

Substances. 

IX. 

On the Burial of the Dead ; and the Cemetery at Mount 
Auburn. 

X. 

On the Death of Pliny the Elder. 

XI, . ■ . 

Remarks and Experiments on Pneumothorax. 

xn. 

On the Pharmacopoeia of the United States. 

XIII. 

On the Mucuna Pruriens ; with Remarks on the Irritability 
of different Textures. 
10* 



73 



XIV 



On the Poisonous Effects of the American Partridge, or 
Ruffed Grouse. 



XV. 

On Coffee and Tea ; arid their INIedicinal Effects. 

XVI. 

Report on the Action of Cochituate "Water on Lead Pipes ; 
and the Influence of the same on Health. 



XVII. 

On the Poisonous Properties of certain American species of 
Rhus. 



XVIII. 

On the History and Use of Tobacco. 

XIX. 

On the Early History of Medicine. 

XX. 

Address delivered before the American Academy of Arts and 
Sciences, at the opening of their Course of Lectures, Oc- 
tober 27, 1852. 



PHILLIPS, SAMPSON & CO 

HATE FOR SALE 

NATUKE AND ART 



CUHE OF DISEASE. 



SIR JOHN FORBES, I. D., D. C. L. (AXON.), F. R. S. 

FEtLOW OF THE KOTAL COLLEGE OF PHYSICIANS, PHYSICIAN TO THE QUEISN'S 
HOUSEHOLD, ETC. ETC. 

" — Quibusdam saltern profutura Tironibus ; quos ut per viarum tutissimarum 
compendia ad saluberrimEe artis deducam cognitionem, allaborandum prEeciputi 
duxi, hos docere, his scribere, animus erat, non Eruditis non Doctoribus ; qui 
enim tam sim vanus, ut erudire eruditos ipse minime eruditus prresumam ? " 

£lias Camerarius. 



FROM THE SECOND LONDON EDITION. 



CONTENTS. 
CHAPTEK I. 



The Author's Eeasons for wi-iting and publishing this volume 
(Introductory) . 

CHAPTER II. 

Of the Ignorance existing respecting the power of Nature 
to cure diseases (Introductory) . 

CHAPTER in. . 

General Notions of 



CHAPTER IV. 

Of the Causes, Mode of Production, and Nature of 



75 

CHAPTER V. 

Of the Course or Progress of 

CHAPTER VI. 

Of the Natural Terminations of Diseases, and the Modes in 
which they take place. 

CHAPTER Vll. 

Evidences in favor of the Curability of Diseases by Nature. 

CHAPTER Vin. 

Of the Existence and General Nature of the Medical Art.. 

CHAPTER IX. 

Instruments of the jMedical Art. 

CHAPTER X. 

Of the Mode of Action of the Instruments of the Medical 
Art : Direct and Specific Action. 

CHAPTER XI. 

Of the Mode of Action of the Instruments of the Medical 
•Art : Indirect or Vicarious Action. 



CHAPTER XII. 

General Estimate of the Povfers of the Medical Art. 



LIBRARY OF CONGRESS 



022216 117 4, 



